Flu Update

Summary of First Month

Lincoln—It’s been one month since Nebraska began preparing for the novel influenza A (H1N1) and activities are ongoing, according to the state’s Chief Medical Officer, Dr. Joann Schaefer, Nebraska Department of Health and Human Services.

“Like I said at the beginning when this virus appeared, we will know much more how this virus will affect us in one to two months,” Dr. Schaefer said.

Here is a recap of what has transpired since then:

On April 25th, a national conference call was held that included the Centers for Disease Control, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and state and local health officials. Callers discussed the 11 cases of H1N1 that had been reported in the United States. Planning immediately began. Health alerts were discussed and the nation began to respond.

On April 26th, DHHS issued an alert to physicians to be on the watch for the virus. The agency ramped up surveillance efforts by notifying its 12 sentinel physicians—doctors who report the number of patients with influenza-like-illness cases they see in their offices. Local health departments, DHHS surveillance staff and the Nebraska Public Health Laboratory were in touch, ready and waiting for the first case. Also on April 26th, DHHS notified the media through a news release that physicians and the public should be on the watch for H1N1.

On April 27th, the DHHS emergency response plan was activated. The Chief Medical Officer authorized the staffing of the DHHS Emergency Coordination Center. This formalized activities within an incident command structure. The Chief Administrator of the DHHS Community Health Section managed the ECC and assigned staff to positions and responsibilities.

On April 28th, the Lt. Governor’s Homeland Security group began meeting. This group consists of representatives from the State Patrol, the Department of Administrative Services, the Nebraska Emergency Response Agency, the Army National Guard and the Chief Medical Officer. The goal of the daily meetings was to see that state operations related to H1N1 were coordinated.

As part of the Nebraska Multi-agency Coordination System, the Nebraska Emergency Management Agency opened the State Emergency Operation Center to coordinate a comprehensive state response.

On April 28th and each day thereafter until May 5th, the Department held media briefings to inform reporters about H1N1, its spread, its symptoms and testing results. The fact that people can’t get this flu from eating pork was stressed. The DHHS Web site offered information on the virus to the public, beginning April 26th.

On April 29th the first case in the state was reported as a probable case. On April 30th the CDC confirmed it. While this individual was from California and would ultimately be counted by the CDC as a California case, DHHS reported it to the public because it seemed necessary that people be alerted that someone within Nebraska’s borders had the illness.

The Douglas County Health Department worked on tracking the contacts of this individual to see if they were experiencing any signs of illness. His contacts were informed that they may have been exposed and should seek medical attention if they had symptoms.

On April 30th, Governor Dave Heineman declared a state of public health emergency, which allowed the Strategic National Stockpile to be distributed, if necessary. This was an administrative move to ensure no barriers would be in the way of a rapid response.

On May 7th, the Nebraska Public Health Laboratory was validated by the CDC to do confirmatory testing for H1N1.

By May 2nd, the virus had been reported in Scotts Bluff County in the west and Douglas County in the east. As of May 26th, there have been 35 confirmed cases reported from 11 counties. This total does not include the California case or a case from Missouri and another from Texas that were diagnosed within Nebraska’s borders. The outbreak, nationally and in Nebraska, is ongoing.

The median age of people affected is 12 in Nebraska, so it is apparent that the virus is disproportionately affecting the young.

Local health departments have continually worked with DHHS to contact physicians, track contacts and recommend antivirals.

Guidance and recommendations from the CDC changed daily as new information was collected. DHHS worked with public health officials across the state and the nation to make sound decisions as the situation changed.

Several schools closed in the state due to cases of H1N1 reported among students. This was before CDC guidance was released that found that this flu seemed no worse than seasonal flu, so school closings were not deemed necessary.

Hospitals have been reporting the number of cases of influenza-like illness that have been hospitalized. Reports from approximately 85 hospitals show that hospitalizations through the week ending May 2nd have been increasing. More recent data is being analyzed to determine if that trend is continuing or if it has leveled off or decreased.

Enhanced and extended influenza testing is uncovering seasonal flu cases as well as H1N1. Usually the seasonal flu season is monitored until May 2nd. Evidence of cases this late in the year is unusual. About 50 percent of test results indicate H1N1.

In addition to the alert sent on April 26th, seven additional health alerts were sent to providers. Providers were instructed to advise patients suspected of being ill with influenza to minimize their contact with other people by staying home from work and school, as well as additional advice on hand washing and cough etiquette (coughing into one’s sleeve rather than hand). DHHS asked providers to counsel people exposed to patients with influenza that they should enter modified quarantine: since they may develop influenza they should minimize their exposure to other people and be prepared to immediately isolate themselves at home at the onset of any flu symptoms. Health care providers were advised to wear N95 respirators whenever possible around infectious patients or, in the absence of these respirators, to use standard surgical face masks for both staff and symptomatic patients. Physicians were asked to contact their local health department if there is a positive rapid flu test. Those departments will obtain the necessary information for public health tracking, follow-up and infection control.

On May 5th, 25 DHHS employees divided the state’s allotment of the federal Strategic National Stockpile. More than 64,700 courses of antivirals and medical supplies were packaged in lots for the local health departments. The 55 pallets took four hours to open up and repackage.

Because H1N1 has the potential to cause significant numbers of deaths, it’s important for public health purposes that DHHS be made aware of resulting deaths in a timely manner. Consequently, the Division of Public Health has embedded a new influenza notification component to the Electronic Death Registration System. If this component is activated, it will enable funeral establishments to report influenza-related deaths to DHHS as part of death certificate reporting. This addition will allow near real-time public health notification of influenza-related fatalities.

On May 27th, the DHHS Vaccine Planning Group will begin meeting. The group’s purpose is to plan for the arrival of vaccine in Nebraska, its storage and distribution, and vaccination. One of its jobs is to review the prioritization of groups to receive vaccine first, which will be directed by the Chief Medical Officer. A factor that will be taken into consideration in this determination include the groups most at risk of complications. This will be determined by CDC guidance and recommendations based on science. It’s possible that it will take two shots of vaccine in order to be prepared for the flu season this fall. The Vaccine Planning Group will look at specific routes and methods of distribution of the vaccine. How much vaccine and when can it be expected are unknown. It’s possible that no vaccine for H1N1 will be available until November or later. DHHS will work with local health departments to determine vaccination procedures.

DHHS has continued to inform the media and the public about the numbers of cases and provides background information through news releases or the DHHS Web site. The message has been and continues to be: Be vigilant about this virus. There will be a great deal to coordinate in the event that the virus mutates or there is an increase in cases.

The advice for the public is:

If you are moderately to severely ill with a cough, sore throat, fever and body aches (and perhaps vomiting and diarrhea), call your physician, who can prescribe an antiviral to ease your symptoms and possibly shorten the duration of your illness.

Stay home from work or school to avoid spreading the virus.

Avoid close contact with people who are coughing or otherwise appear ill.

Avoid touching eyes, nose and mouth.

Cover mouth and nose with a tissue when you cough or sneeze or cough or sneeze into your upper sleeve.